Falling stroke rates during COVID-19 pandemic at a comprehensive stroke center

J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104953. doi: 10.1016/j.jstrokecerebrovasdis.2020.104953. Epub 2020 May 14.


Introduction: Although there is evidence to suggest a high rate of cerebrovascular complications in patients with SARS-CoV-2 infection, anecdotal reports indicate a falling rate of new ischemic stroke diagnoses. We conducted an exploratory single-center analysis to estimate the change in number of new stroke diagnoses in our region, and evaluate the proximate reasons for this change during the COVID-19 pandemic at a tertiary care center in New Jersey.

Patients and methods: A Comprehensive Stroke Center prospective cohort was retrospectively analyzed for the number of stroke admissions, demographic features, and short-term outcomes 5 months prior to 3/1/2020 (pre-COVID-19), and in the 6 weeks that followed (COVID-19 period). The primary outcome was the number of new acute stroke diagnoses before and during the COVID-19 period, as well as the potential reasons for a decline in the number of new diagnoses.

Results: Of the 328 included patients, 53 (16%) presented in the COVID-19 period. There was a mean fall of 38% in new stroke diagnoses (mean 1.13/day [SD 1.07] from 1.82/day [SD 1.38], p<0.01), which was related to a 59% decline in the number of daily transfers from referral centers (p<0.01), 25% fewer telestroke consultations (p=0.08), and 55% fewer patients presenting directly to our institution by private vehicle (p<0.01) and 29% fewer patients through emergency services (p=0.09). There was no significant change in the monthly number of strokes due to large vessel occlusion (LVO), however the proportion of new LVOs nearly doubled in the COVID-19 period (38% vs. 21%, p=0.01).

Conclusions: The observations at our tertiary care center corroborate anecdotal reports that the number of new stroke diagnoses is falling, which seems related to a smaller proportion of patients seeking healthcare services for milder symptoms. These preliminary data warrant validation in larger, multi-center studies.

Keywords: COVID-19; Coronavirus; Epidemiology; Incidence; Ischemic Stroke.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Betacoronavirus / pathogenicity
  • COVID-19
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / virology
  • Emergency Medical Services
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • New Jersey / epidemiology
  • Pandemics
  • Patient Acceptance of Health Care
  • Patient Transfer
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / virology
  • Remote Consultation
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Stroke / diagnosis
  • Stroke / epidemiology*
  • Stroke / therapy
  • Stroke / virology
  • Tertiary Care Centers*
  • Time Factors